1

DENTAL MATERIALSDENTAL MATERIALSHigh Tech AdvancesHigh Tech Advancesand New Materialsand New Materials

Stephen C. BayneStephen C. BayneDepartment of Operative DentistryDepartment of Operative DentistrySchool of DentistrySchool of DentistryUniversity of North CarolinaUniversity of North CarolinaChapel Hill, NC 27599Chapel Hill, NC 27599--74507450

http: // www.dent.unc.edu / portfolios / bayne / dental-materials /

A. A. Staying UPStaying UP--TOTO--DATEDATEB.B. Dental Materials TECHNOLOGIESDental Materials TECHNOLOGIES

> Advanced composites> Advanced composites> Dentin bonding systems> Dentin bonding systems> Light> Light--curing technologiescuring technologies> Sonic and ultrasonic cleaning devices> Sonic and ultrasonic cleaning devices> Lasers for cutting tooth structure> Lasers for cutting tooth structure> Advanced CAD/CAM> Advanced CAD/CAM> > ProceraProcera crownscrowns> Air> Air--abrasion equipmentabrasion equipment> Amalgam / Hg recovery equipment> Amalgam / Hg recovery equipment> Computerized color analysis> Computerized color analysis> Electronic caries detectors> Electronic caries detectors

C.C. Office TECHNOLOGIESOffice TECHNOLOGIES> Wearable computers> Wearable computers> Wireless office > Wireless office networdsnetwords

OVERVIEWOVERVIEW

http://www.net32.com/http://www.net32.com/

Pat Cassidy, D.D.S.Pat Cassidy, D.D.S.Durham, NCDurham, NC

COMPOSITE REFINEMENTSCOMPOSITE REFINEMENTS

19501950 1970197019601960 20102010200020001990199019801980

OriginalOriginalDevelopmentDevelopment

SELFSELF--CUREDCURED

UVUV--CUREDCURED

VLCVLC--CUREDCURED

MACROFILLMACROFILLSelfSelf--CuredCured

CompositesComposites

MIDIFILLMIDIFILLCompositesComposites

MICROFILLMICROFILLCompositesComposites

MIDIFILLMIDIFILLCompositesComposites

MidiMidi--HYBRIDHYBRIDCompositesComposites

UnbondedUnbondedCompositesComposites

AcidAcid--Etching andEtching andEnamel BondingEnamel Bonding

DentinDentin--BondedBondedCompositesComposites 3c, 2c, 1c3c, 2c, 1c

Dentin Bonding SystemDentin Bonding System

[QTH, PAC, Laser,[QTH, PAC, Laser, LEDLED]]

MiniMini--HYBRIDHYBRIDCompositesComposites

FLOWABLESFLOWABLES

PACKABLESPACKABLES

CONTROLLEDCONTROLLEDSHRINKAGESHRINKAGE

NANONANO--COMPOSITECOMPOSITE

1990 2000 2010The nextThe nextgeneration.generation.

Dental amalgamDental composite

Glass Ionomer, A.R.T.Bonding systemsDental cementsCeramic restorationsCAD/CAM technologyEsthetic procedures

Computers

- - - - - - -, (A.R.T.)Mini- (Micro-) Hybrid, NanoFlowable Hybrid,Packable Hybrid,CS Composites- - - , RMGI Cements, A.R.T.(Bonding systems)RMGI, Composite cementsALL-CERAMIC restorationsCAD/CAM technologyESTHETIC Procedures

COMPUTERS

2

CURRENT COMPOSITESCURRENT COMPOSITESHYBRIDS (or MIDIHYBRIDS (or MIDI--HYBRIDS):HYBRIDS):FiltekFiltek Z250Z250 and Z100 (3M)and Z100 (3M)PrismaPrisma APH and APH and TPHTPH (Dentsply)(Dentsply)TPH Spectrum (Dentsply)TPH Spectrum (Dentsply)HerculiteHerculite XRV and XRV and ProdigyProdigy (Kerr)(Kerr)EcusitEcusit Composite (DMG Hamburg)Composite (DMG Hamburg)TetricTetric CeramCeram ((IvoclarIvoclar/Vivadent)/Vivadent)Renew (BISCO)Renew (BISCO)BisFilBisFil II and 2B (BISCO)II and 2B (BISCO)Synergy (Synergy (ColteneColtene--WhaledentWhaledent))Marathon (Marathon (DenmatDenmat))ClearfilClearfil APAP--X (Morita)X (Morita)

MINIMINI--HYBRIDS (MICROHYBRIDS (MICRO--HYBRIDS):HYBRIDS):EsthetEsthet--X (Dentsply)X (Dentsply)Point 4 (Kerr)Point 4 (Kerr)Venus (Venus (HereausHereaus--KulzerKulzer))VitalescenceVitalescence ((UltradentUltradent))

FLOWABLES: FLOWABLES: (later)(later)

PACKABLES: PACKABLES: (later)(later)

MICROFILLS:MICROFILLS:SuperluxSuperlux (DMG Hamburg)(DMG Hamburg)HeliomolarHeliomolar ((IvoclarIvoclar/Vivadent)/Vivadent)MicroNewMicroNew (BISCO)(BISCO)Perfection (Perfection (DenmatDenmat))FiltekFiltek A110 = A110 = SiluxSilux PlusPlus (3M)(3M)AmelogenAmelogen ((UltradentUltradent))Virtuoso Virtuoso SculptableSculptable ((DenmatDenmat))

NANONANO--HYBRIDS:HYBRIDS:Supreme (3MSupreme (3M--ESPE)ESPE)Simile (Pentron)Simile (Pentron)

COMPOSITE WEARCOMPOSITE WEAR

5 Wear Types:5 Wear Types:

CFA = CFA = foodfood bolusbolus wearwearOCA = impact wearOCA = impact wearFCA = sliding wearFCA = sliding wearPCA = sliding wearPCA = sliding wearTBA = abrasive wearTBA = abrasive wear

CFA WearOCA Wear

FCA Wear

PCAWear

TBA Wear

Wilder AD, May KN, Bayne SC, Taylor DF, Leinfelder KF. 17-year clinical evaluation of UV-cured composite resinsin posterior teeth. J Dent Res 1996; 75: 173, Abstr 2100.

100

200

300

1 2 5 10 20TIME (years)

WEA

R (C

FA, µ

m)

R2 = 0.99

ENAMELENAMEL

““MACRO”MACRO”FILLERFILLER

““MIDI”MIDI”FILLERFILLER

““MINI”MINI”FILLERFILLER

““MICRO”MICRO”FILLERFILLER

40 40 µµmm 4 4 µµmm 0.4 0.4 µµmm 0.04 0.04 µµmm

FOOD BOLUSFOOD BOLUSAbrasiveAbrasive

HYBRID(MIDIFILL)

HYBRID(MINIFILL)

Rough FinishedRough Finished Fine FinishedFine Finished

AFM OF SURFACESAFM OF SURFACES FILLER PRODUCTIONFILLER PRODUCTION

BULK FILLER PRODUCTION:Melting or vitrification.Cooled to solid.Ground and sifted.Reground and sifted.Key particle size is collected.

MACRO, MIDI, MINI

GAS PHASE PRECIPITATION:Pyrolysis of reactants.Gas phase formation.Precipitation.Cooling.

MICRO

SOL-GEL FORMATION:Solution reaction.Formation of tiny ceramic domains.Domains may be single or clustered.Gel dried and powdered.

MICRO, NEAR-NANO, NANO

3

DECEPTIVE NAMESDECEPTIVE NAMESNanocomposites = constituents mixed at a nano-length scale.

101000 1010--11 1010--33 1010--44 1010--55 1010--66 1010--77 1010--88 1010--99 1010--10101010--22

1 m1 m 1 cm1 cm 1 1 µµmm1 mm1 mm 1 nm1 nm1 dm1 dm

0.010.011 1 µµmm 0.10.11010100100 0.0010.001

Mega-Fill

Macro-Fill

Midi-Fill

Mini-Fill

Micro-Fill

Nano-Fill

1 Å

AtomicAtomicDimensionsDimensionsBacteriaBacteria

METERSMETERS

Dentinal TubuleDentinal TubuleWidthWidth

Nanocomposites?Dental nanofillers?

HYBRIDHYBRID NANOMERNANOMER NANOCLUSTERNANOCLUSTER

NANOCOMPOSITESNANOCOMPOSITES

3M ESPE Filtek Supreme, Technical Product Profile, October 2002

FILTEK SUPREME (3MFILTEK SUPREME (3M--ESPE)ESPE)

78.5 w/o filler loading Nano-cluster size is 0.6-to-1.4 µmCalled a micro- or nano-hybrid?

SIMILE (Pentron)SIMILE (Pentron)

Relatively high filler loading Silicate cage size is 5-20 nmCalled a micro- or nano-hybrid?

The The ““WARWAR”” of theof thePOWERED TOOTHBRUSHESPOWERED TOOTHBRUSHES

ColgateColgateActibrushActibrushWaterPikWaterPik

SensonicSensonic

CybersonicCybersonicOralOral--BB

3D Excel3D Excel

SonicareSonicare

Crest Spin BrushCrest Spin Brushfor Kidsfor Kids

OralgenieOralgenie

PTB’s are everywhere!

SEM surface of SEM surface of biopsiedbiopsied 1010--yearyearold posterior composite.old posterior composite.

BIOFILM EFFECTSBIOFILM EFFECTS

4

Dr. Bill Dr. Bill CostertonCosterton, Center for Biofilm Engineering, Montana State University, Boze, Center for Biofilm Engineering, Montana State University, Bozemanman

BIOFILM EFFECTSBIOFILM EFFECTS

pH, pO2

FLOWABLE COMPOSITESFLOWABLE COMPOSITESDefinition:Definition: lower viscosity dental composite, generally lower viscosity dental composite, generally with lowered filler content.with lowered filler content.

First Generation Flowable:First Generation Flowable:AeliteFloAeliteFlo (BISCO)(BISCO) HighHigh 43% by volume43% by volumeCrystalessenceCrystalessence ((ConfiConfi--Dental)Dental) LowLow 41% by volume41% by volumeFloRestoreFloRestore (Den(Den--Mat)Mat) MediumMedium 48% by volume48% by volumeFlowFlow--It It ((Jeneric/PentronJeneric/Pentron)) LowLow 53% by volume53% by volumeRevolution Revolution (Kerr)(Kerr) MediumMedium 41% by volume41% by volumeStar Flow Star Flow (Danville Eng.)(Danville Eng.) LowLow 41% by volume41% by volumeTrue Look True Look ((DenpacDenpac / 5 Star)/ 5 Star) MediumMedium 53% by volume53% by volumeUltrasealUltraseal XT+ XT+ ((UltradentUltradent)) Very LowVery Low 37% by volume37% by volumeVersafloVersaflo ((CentrixCentrix)) HighHigh 43% by volume43% by volume

Second Generation Second Generation FlowablesFlowables::FiltekFiltek Flow Flow (3M)(3M)Wave Wave (SDI)(SDI)TetricTetric Flow Flow ((IvoclarIvoclar/Vivadent)/Vivadent)HeliomolarHeliomolar Flow Flow ((IvoclarIvoclar/Vivadent)/Vivadent)PointPoint--4 Flowable 4 Flowable (Kerr)(Kerr)AeliteFloAeliteFlo LV LV (BISCO)(BISCO)EsthetEsthet--X X FloFlo ((DentsplyDentsply))LuxaLuxa--FlowFlow (DMG)(DMG)PermaFloPermaFlo ((UltradentUltradent))MetaMeta--FloFlo (Sun Medical)(Sun Medical)AriaAria (Danville Engineering)(Danville Engineering)Star FlowStar Flow (Danville Engineering)(Danville Engineering)FlowFlow--ItIt--ALCALC (Pentron)(Pentron)Revolution Formula 2Revolution Formula 2 (Kerr)(Kerr)Virtuoso FlowVirtuoso Flow ((DenmatDenmat))UltraSealUltraSeal XT+XT+ ((UltradentUltradent))UniFilUniFil FlowFlow (GC America)(GC America)

Bayne SCBayne SC, Thompson JY, Swift EJ , Thompson JY, Swift EJ JrJr, , StamatiadesStamatiades P, P, WildersonWilderson M.M. A characterization A characterization of firstof first--generation flowable composites.generation flowable composites. J Am Dent Assoc 1998;129:567J Am Dent Assoc 1998;129:567--577.577.

FLOW BUTTONSFLOW BUTTONS(area calculated in mm(area calculated in mm22))

EnamelEnamel

DentinDentinFlowableFlowableCompositeComposite

CompositeComposite

Second Generation Flowables

67 ±453 ±058 ±435 ±351 ±2140 ± 2 bPoint 4 Flowable (Kerr)85 ±583 ±573 ±353 ±1054 ±3144 ±10 bFiltek Flow (3M-ESPE)62 ±863 ±472 ±447 ±741 ±5148 ±27 bMetaFil Flo (Sun Dental)60 ±450 ±452 ±435 ±538 ±1152 ±10 bcFlow-It ALC (Pentron)62 ±356 ±345 ±323 ±438 ±1156 ±13 acTetric Flow (Ivoclar)62 ±452 ±255 ±337 ±539 ±4156 ± 6 acLuxaFlow (DMG)62 ±866 ±761 ±534 ±323 ±1159 ±17 acRevolution F2 (Kerr)47 ±347 ±433 ±315 ±224 ±1173 ±21 acUniFil Flow (GC)46 ±245 ±444 ±119 ±126 ±2191 ±13 acHeliomolar Flow (Ivoclar)48 ±443 ±339 ±419 ±124 ±2197 ±31 acFlowLine (Kulzer)31 ±337 ±131 ±317 ±622 ±4206 ±20 acWave (SDI)55 ±544 ±340 ±722 ±331 ±5208 ±16 aStarFlow (Danville)

θ,Mylar

θ,Glass

θ,PLP

θ,OSP

θ,PBNT

Flow(mm2)

Flowable(Company)

FLOW versus WETTINGθ = 25°

θ = 45°

PACKABLE RESTORATIVESPACKABLE RESTORATIVESavailable in November 2002available in November 2002

•• SOLITAIRE and SOLITAIRE 2 SOLITAIRE and SOLITAIRE 2 ((HereausHereaus--KulzerKulzer))•• A.L.E.R.T. CONDENSABLE A.L.E.R.T. CONDENSABLE ((JenericJeneric--PentronPentron))•• SUREFIL SUREFIL (LD Caulk(LD Caulk))•• GLACIER GLACIER (Southern Dental Industries)(Southern Dental Industries)•• PYRAMID PYRAMID (BISCO)(BISCO)•• PRODIGY CONDENSABLE PRODIGY CONDENSABLE (Kerr)(Kerr)•• FILTEK P60 FILTEK P60 (3M)(3M)•• SYNERGY COMPACTSYNERGY COMPACT ((ColteneColtene / / WhaledentWhaledent))•• HELIOMOLAR HB HELIOMOLAR HB ((IvoclarIvoclar--Vivadent)Vivadent)•• HIHI--DENSE CONDENSABLE GI DENSE CONDENSABLE GI ((ShofuShofu))•• FUJI IX PACKABLE FUJI IX PACKABLE (GC(GC--America)America)

L.D. CAULK SUREFILL.D. CAULK SUREFILPACKABLE COMPOSITEPACKABLE COMPOSITE

SureFilSureFil Clinical Wear (Leinfelder Indirect) = Clinical Wear (Leinfelder Indirect) = 1818 ±± 3232 µµm at 2 yrsm at 2 yrs

Clinical Performance Categories (% Clinical Performance Categories (% alfaalfa):): BL BL 6m 6m 1y 1y 2y 2y Color stability =Color stability = 100100 9898 9696 87 87 Resistance to marginal discoloration =Resistance to marginal discoloration = 100100 100100 9595 100100Resistance to secondary caries = Resistance to secondary caries = 100100 100100 9898 100100Resistance to occlusal wear = Resistance to occlusal wear = 100100 100100 9898 9494Marginal adaptation = Marginal adaptation = 100100 9797 9595 9696Surface texture =Surface texture = 100100 100100 9898 9494Maintenance of proximal contact =Maintenance of proximal contact = 9797 9797 9696 9898Functional occlusion =Functional occlusion = 9393 9898 9595 100100Axial contour =Axial contour = 100100 100100 100100 100100Resistance to postoperative sensitivity =Resistance to postoperative sensitivity = 100100 9898 100100 100100Restoration retention = Restoration retention = 100100 100100 100100 100100Resistance to restoration fracture =Resistance to restoration fracture = 100100 9898 9393 9696TOTAL FAILURES (%) =TOTAL FAILURES (%) = 0%0% 3%3% 3%3% 4%4%

Wear (ADA Proposed Type B Unrestricted) Wear (ADA Proposed Type B Unrestricted) ≤≤ 5050 µµm at 18 monthsm at 18 months

5

0 25 50 75 1000

2

3

4

5

CONVERSION (%)

SHR

INK

AG

E (%

)

1

65%65%ConversionConversion

1515--25% =25% =GellationGellation

50% Filler25% Bis-GMA25% TEGDMA

POLYMERIZATION SHRINKAGEPOLYMERIZATION SHRINKAGE

Flow

Bond Stretching(External Contraction)

Porosity Formation(Internal Contraction)

NEW COMPOSITE GENERATIONNEW COMPOSITE GENERATION= Low= Low--Shrinkage or ControlledShrinkage or Controlled--Shrinkage CompositesShrinkage Composites

C C

O

Oxiranes

C

CC

O

Oxetanes

SHRINKING Monomers:

EXPANDING Monomers:

CH2CHCH 2OC=C

H

H CH3

COO OCH2CHCH2CCH3

CH3

OOCC=C

H

HH3COHOH

BIS-GMA

Spiro-ortho-carbonates

O

O

O

O

O

O

O

O

DOXADENTDOXADENTCondensable Direct CeramicCondensable Direct Ceramic

http:// www.doxa.se/ eng/

Carved

Finished

DOXADENTDOXADENTMechanical PropertiesMechanical Properties

0

100

200

300

400

500

Doxa Z250 Tytin

CO

MPR

ESSI

VE S

TREN

GTH

(MPa

)

1h24h1w4w

Composite Amalgam

Experimental

BONDED COMPOSITEBONDED COMPOSITEChallengesChallenges

50

1000

4000

3000

2000

BO

ND

ED C

OM

POSI

TE (1

mm

= 1

000µ

m)

[DENTIN][DENTIN]1

Bacteria

[Bonding System][Bonding System]

[COMPOSITE][COMPOSITE]

[COMPOSITE][COMPOSITE]

ReRe--Designing Bonding SystemsDesigning Bonding Systems

ETCHANTPRIMER

BONDING AGENT

US Companies

1 =

2 =

Japanese Companies

= 1

= 2

???

E + E + nnPP + + BB or or nEnEPP + + BBE + E + nnPPBB EEPPBBSelfSelf--Etching PrimerEtching Primer

SelfSelf--Etching Etching AdhAdh

6

NEWER BONDING AGENTSNEWER BONDING AGENTS1-COMPONENT SYSTEMS (EPB)• AQBond (Sun Medical)

or Touch-and-Bond (Parkell)• Adper Prompt or LP3 (3M-ESPE)• Solist (One-bottle-bond) (DMG Hamburg)• iBond (Hereaus-Kulzer)• Xeno III (Dentsply)

2-COMPONENT SYSTEMS (EP + B)• Clearfil SE Bond & LinerBond 2v (Kuraray)• Tyrian SPE (Bisco)• Optibond Solo SE Plus (Kerr)• Fluoro Bond (Shofu)• UniFil Bond (GC)• Mac Bond II (Tokuyama)• NanoBond (Pentron)

2-COMPONENT SYSTEMS (E + PB)• Prime&Bond NT (Dentsply)• Single-Bond (3M)• Optibond Solo and Solo Plus (Kerr)• One-Step (BISCO)• Excite (Ivoclar/Vivadent)• OSB Bonding System (ESPE)

• Syntac Single Component (Ivoclar)• Ecusit Primer/Mono (DMG Hamburg)• One Coat Bond (Coltene / Whaledent)• Bond-1 (Jeneric / Pentron)• Tenure Quik with Fluoride (Denmat)• Solid Bond (Hereaus-Kulzer)• Imperva Bond (Shofu)• EG Bond (Sun Chemical) • PQ1 (Ultradent)• Easy Bond (Parkell)• Paama 2 and Stae (SDI)

3-COMPONENT SYSTEMS (E + P + B)• Scotchbond Multipurpose Plus (3M)• Permaquick (Ultradent)• Bond-It (Jeneric / Pentron)• All-Bond 2 (BISCO)• Tenure A/B/S (Denmat)• ProBond (Dentsply)

HOWHOWMUCHMUCH

SOLVENT?SOLVENT?

Scotchbond Multipurpose Plus3M Dental Products Division(Ethanol and water solvent system)(Ethanol and water solvent system)

33--STEPSTEP

Prime&BondPrime&BondDentsply InternationalDentsply International(Acetone solvent system)(Acetone solvent system)

22--STEPSTEP

Single BondSingle Bond3M Dental Products Division3M Dental Products Division(Ethanol and water solvent system)(Ethanol and water solvent system)

22--STEPSTEP

11--STEPSTEP

Prompt LPrompt L--Pop Pop 3M ESPE Dental Products3M ESPE Dental Products(Ethanol and water solvent system)(Ethanol and water solvent system)

EtchingEtching

33--Component Systems (E+P+B)Component Systems (E+P+B)

Priming AgentPriming AgentBonding AgentBonding Agent

HYBRID LAYERHYBRID LAYER

EtchingEtching

Priming AgentPriming AgentBonding AgentBonding Agent

22--Component Systems (E+PB)Component Systems (E+PB)

HYBRID LAYERHYBRID LAYER

22--Component Systems (EP+B)Component Systems (EP+B)SelfSelf--Etching PrimerEtching Primer

Infiltrated Smear Layer =Infiltrated Smear Layer =Special Hybrid LayerSpecial Hybrid Layer

Infiltrated Dentin =Infiltrated Dentin =Normal HYBRID LAYERNormal HYBRID LAYER

Bonding SystemBonding System

HYBRID LAYERHYBRID LAYER

11--Component Systems (EPB)Component Systems (EPB)SelfSelf--Etching AdhesiveEtching Adhesive

Infiltrated Smear Layer =Infiltrated Smear Layer =Special Hybrid LayerSpecial Hybrid Layer

Infiltrated Dentin =Infiltrated Dentin =Normal HYBRID LAYERNormal HYBRID LAYER

Bonding SystemBonding System

HYBRID LAYERHYBRID LAYER

7

CURING LIGHT TYPESCURING LIGHT TYPES•• QuartzQuartz-- TungstenTungsten-- Halogen (QTH) LightsHalogen (QTH) Lights

> Continuous output > Continuous output ---- normal intensitynormal intensity> Continuous output > Continuous output ---- high intensityhigh intensity> Staged output (stepped, ramped, …)> Staged output (stepped, ramped, …)

•• Plasma Arc Curing (PAC) LightsPlasma Arc Curing (PAC) Lights•• ArgonArgon-- Laser Curing (Laser) LightsLaser Curing (Laser) Lights•• LightLight-- Emitting Diode (LED) LightsEmitting Diode (LED) Lights

QTHQTH PACPAC LaserLaser LEDLED

Curing EquipmentCuring EquipmentFactorsFactors

ProceduralFactors

RestorationFactors

FACTORS AFFECTING CUREFACTORS AFFECTING CURE•• Bulb frosting or degradationBulb frosting or degradation•• Light reflector degradationLight reflector degradation•• Optical filter degradationOptical filter degradation•• FiberFiber--optic bundle breakageoptic bundle breakage•• LightLight--guide fractureguide fracture•• Tip contamination by resin buildupTip contamination by resin buildup•• Line voltage inconsistenciesLine voltage inconsistencies•• Sterilization problemsSterilization problems•• Infection control barriers Infection control barriers

•• Light tip directionLight tip direction•• Access to restorationAccess to restoration•• DISTANCE from surfaceDISTANCE from surface•• Size of tipSize of tip•• Tip movementTip movement•• TIME of exposureTIME of exposure

•• Restoration thicknessRestoration thickness•• Cavity design Cavity design •• Filler Filler -- amount and sizeamount and size•• Restoration shadeRestoration shade•• Monomer ratiosMonomer ratios

WAVELENGTH (nm)WAVELENGTH (nm)

UVUV VisibleVisible IRIRCQCQ

INTE

NSI

TYIN

TEN

SITY

UVUVbandband--passpassfilterfilter

IRIRbandband--passpassfilterfilter

INTRAPULPAL HEAT,INTRAPULPAL HEAT,GINGIVAL IRRITATIONGINGIVAL IRRITATION

180180--800800mW/cm2mW/cm2

WAVELENGTH (nm)WAVELENGTH (nm)

VisibleVisible CQCQ

INTE

NSI

TYIN

TEN

SITY

LED LIGHTSLED LIGHTSLight Emitting DiodesLight Emitting Diodes

Advantages:Advantages:Matched to CQ peak.Matched to CQ peak.Reduced Reduced ““II”” needed.needed.Easy to clean.Easy to clean.Totally quiet; No fan.Totally quiet; No fan.Small; Handy.Small; Handy.No wires.No wires.

EliparElipar FREELIGHT 1FREELIGHT 1Batteries

LEDs

LED LIGHTS in the WORLDLED LIGHTS in the WORLD

8

LED CURING LIGHTSLED CURING LIGHTSVLC LED Name:VLC LED Name: Company:Company: Price:Price: LEDs:LEDs:

EliparElipar FreeLightFreeLight 3M3M ESPE ESPE $ 999$ 999 1919NRG NRG Dentsply/CaulkDentsply/Caulk $ 949$ 949 77Ultra Ultra LumeLume LED 1LED 1 UltradentUltradent $ 899 ($699)$ 899 ($699)Ultra Ultra LumeLume LED 2LED 2 UltradentUltradent $1299 ($999)$1299 ($999)CoolBlueCoolBlue Dental SystemsDental Systems $1195$1195NovaNova Curing Curing TechologiesTechologies $1495$1495 77GC eGC e--LightLight GC AmericaGC America $1495$1495AllegroAllegro DenmatDenmat -- -- -- -- -- 11EliparElipar FreeLightFreeLight 22 3M3M ESPE ESPE $1495$1495 11LEDemetronLEDemetron KerrKerr -- -- -- -- -- 11UltraUltra--LumeLume LED 5LED 5 UltradentUltradent -- -- -- -- -- 55

OUTPUT OUTPUT ∝∝ LED power,LED power,LED #,LED #,Light Collection, Light Collection, FocusingFocusing

GICGIC

COMPOSITECOMPOSITE

RMRM--GICGICGIC andVLC Hydrophilic monomer and polymer

CEMENTSCEMENTS

MMMM--GICGICGIC andMetallic fillersCermet fillers

CORESCORES

COMPOMERCOMPOMERVLC Composite andF source

FILLING MATERIALSFILLING MATERIALS

RRRR--GICGICGIC andResin-Fillers

A.R.T. andA.R.T. andTEMPORARIESTEMPORARIES

GIOMERGIOMERVLC Composite andPre-reacted GIC powder

FILLING MATERIALSFILLING MATERIALS

HYDROGELHYDROGEL

Hydrophobic POLYMERHydrophobic POLYMER

A.R.T. TECHNIQUEA.R.T. TECHNIQUE(Atraumatic Restorative Technique)

Fuji IX

Now being used as permanent restoration in pedodontics.

Developed as temporary restorations for 3rd world countries.First tested in African countries.Now used widely in Asian countries.

Current technique = P/L or precapsulated mixture.Original technique = scoop, finger mix, finger insertion.

OVERVIEWOVERVIEWAMALGAMAMALGAMDISDIS--USEUSE

HgHgCONTROVERSYCONTROVERSY

ININ--OFFICEOFFICEISSUESISSUES

ENVIRONMENTALENVIRONMENTALISSUESISSUES

F, Sealants, HighF, Sealants, High--Cu Amalgam, Composites, Replacement Criteria Cu Amalgam, Composites, Replacement Criteria

n=150 per100 patientsn=150 per100 patientsIn United StatesIn United States

n= 95n= 95 n=55n=55

HalHalHugginsHuggins

60 Minutes60 MinutesProgramProgram

StoneStonePhillipsPhillips

AntiAnti--AmalgamistsAmalgamists

19801980 201020102000200019901990

??

Precapsulated Dental AmalgamsPrecapsulated Dental Amalgams

ADA Hg HygieneADA Hg HygieneStatementStatement

ChairsideChairsideFiltersFilters SeparatorsSeparators

Air, Water, Land, FoodAir, Water, Land, Food

USUS--EPAEPA OSHAOSHA FDAFDA NASNAS

1.1. Dental AmalgamDental Amalgam(a)(a) Spent Amalgam CapsulesSpent Amalgam Capsules(b)(b) “Non“Non--Contact” Amalgam (leftContact” Amalgam (left--over from mixing procedures)over from mixing procedures)(c)(c) ChairChair--side Traps (“contactside Traps (“contact--amalgam” trapped by amalgam” trapped by coarse filtercoarse filter))(d)(d) Vacuum Pump Filter (“contactVacuum Pump Filter (“contact--amalgam” trapped by amalgam” trapped by medium filtermedium filter))(e)(e) Separator or Recapture Device (added before vacuum with Separator or Recapture Device (added before vacuum with fine filterfine filter))(f)(f) Plumbing and Sink TrapsPlumbing and Sink Traps(g)(g) Hg Spill KitsHg Spill Kits

2.2. XX--ray Wastesray Wastes(a)(a) Fixer (Ag recovery or recycling processes)Fixer (Ag recovery or recycling processes)(b)(b) Developer (controlled discharge into sanitary sewer)Developer (controlled discharge into sanitary sewer)(c)(c) Cleaners (CrCleaners (Cr--containing cleaners must be recycled)containing cleaners must be recycled)(d)(d) Lead foil (must be recycled)Lead foil (must be recycled)(e)(e) Lead Shields (e.g., aprons) (must be recycled)Lead Shields (e.g., aprons) (must be recycled)

3.3. Chemical Chemical SterilantSterilant WastesWastes(a)(a) Chemiclave/ChemicalChemiclave/Chemical--SterilantSterilant (dilute 4:1 with water before draining)(dilute 4:1 with water before draining)

4.4. Waste WatersWaste Waters

5.5. Fluorescent Lamps and Batteries (recycle only)Fluorescent Lamps and Batteries (recycle only)

Best Management PracticesBest Management Practices[ Use alternatives / Keep products separate / Recycle everything[ Use alternatives / Keep products separate / Recycle everything ]]

HgHg--SpillSpill

AmalgamAmalgamStorageStorage

HG HYGIENEHG HYGIENE PLUMBINGPLUMBING

AmalgamAmalgamMixingMixing

Sink TrapsSink Trapsand Plumbingand Plumbing

Suction MiniSuction Mini--TrapTrap

Chairside FilterChairside Filter

SeparatorSeparator

Vacuum PumpVacuum PumpFilter or TrapFilter or Trap

Vacuum PumpVacuum Pump

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STUDY QUESTIONS: 1. Which one of the following online-ordering sites truly exists? a. DentalBuy.com b. NET32.com c. OnlineDentalSupplies.com d. DentalSavings.com e. DentalProducts.com 2. Which one of the following is NOT a category of dental composites? a. Packables b. Flowables c. Nanocomposites d. Microfills e. A.R.T. 3. What types of fillers are mixed together in standard hybrid composites? a. Midifiller and Minifiller b. Minifiller and Microfiller c. Microfiller and Nanofiller d. Midifiller and Microfiller e. Minifiller and Nanofiller 4. What types of fillers are mixed together in mini-hybrid composites? a. Midifiller and Minifiller b. Minifiller and Microfiller c. Microfiller and Nanofiller d. Midifiller and Microfiller e. Minifiller and Nanofiller 5. What types of fillers are mixed together in nano-hybrid composites? a. Microfiller and Nanofiller b. Minifiller and Nanofiller c. Microfiller and Nano-clusters d. Microfiller and Nanomers e. Nanomers, Nanoclusters, and Midifiller 6. Nanofillers are produced by which of the following processes? a. Coarse grinding of powders b. Fine grinding of powders c. Sol-gel processes d. Vapor phase deposition e. Spraying liquid silica 7. Which one of the following is not a true statement about biofilms? a. The base layer involves cells attached by a polysaccharide coating. b. Biofilms have extensive channels among mushroom plumes of cells. c. Biofilms can migrate across a surface to relocate the entire film. d. Cells in biofilms easy destroyed by standard antibiotics. e. Biofilms are found universally in moist environments regardless of bacterial cell type.

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8. Which one of the following statements characterizes second generation flowable composites?

a. Much better flow than first generation products. b. All products are almost the same strength as standard hybrid composites. c. Much greater depth of cure than regular composites. d. Do not adapt well to bonded dentin surfaces. e. Are more difficult to cure with visible light than other composites. 9. Which one of the following materials is NOT a packable composite? a. Filtek Supreme b. SureFil c. A.L.E.R.T. d. Prodigy Condensable e. Solitaire 2 10. Which one of the following is an expanding monomer? a. Hydroxyethyl methacrylate (HEMA) b. BIS-GMA c. Methyl methacrylate (MMA) d. Oxirane e. Silane 11. What is DOXADENT? a. Nanocomposite produced in Europe b. Flowable composite c. Directly-placed ceramic restoration d. LED curing light e. Powered toothbrush 12. Which of the following is NOT a category of dentin bonding systems? a. 3-component total-etch system b. 2-component total-etch system c. 2-component self-etching primer (SEP) d. 1-component self-etching adhesive (SEA) e. 0-component self-etching composite (SEC) 13. What is the reason for applying several coats of primers, self-etching primers, or

self-etching adhesives during bonding procedures? a. Insure adequate film formation after solvent loss b. Increase the strength of the bonding layer c. Increase the water resistance of the cured film d. Increase the fatigue resistance of the adhesive e. To minimize oxygen inhibition during VL curing 14. What is the typical solvent level range for dentin bonding systems? a. 10-30% b. 20-50% c. 45-50% d. 55-60% e. 60-90%

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15. What is the hybrid layer? a. Zone of collagen surrounded by resin within intertubular dentin b. A layer of resin in which there is a combination of filler particle sizes c. A double layer produced by primer and then bonding agent d. Resin that has mixed with dentinal fluid and filled the tubules e. Any resin layer that includes HEMA in the composition 16. What is the third major category of variables affecting visible light curing in

addition to “curing equipment factors” and “procedural factors”? a. Restoration factors b. Patient factors c. Intraoral location factors d. Oral hygiene factors e. Surface contamination factors 17. Which one of the following is NOT a category of visible light curing units? a. Argon laser curing units b. L.E.D. curing units c. RF curing units d. Quart-Tungsten-Halogen curing units e. Plasma arc curing units (PAC) 18. What is the active absorber of visible light in a dental composite that initiates

polymerization? a. BIS-GMA b. Glass filler c. Silane coupling agent d. Camphoroquinone e. Hydroquinone 19. What is the minimum output expected for standard QTH visible light curing units? a. 100 mW/cm2 b. 200 mW/cm2 c. 300 mW/cm2 d. 400 mW/cm2 e. 600 mW/cm2 20. What is the standard operating output for many QTH visible light curing units? a. 100 mW/cm2 b. 300 mW/cm2 c. 600 mW/cm2 d. 1000 mW/cm2 e. 1500 mW/cm2 21. What is the standard output for third-generation LED visible light curing units? a. 100 mW/cm2 b. 200 mW/cm2 c. 300 mW/cm2 d. 600 mW/cm2 e. 800-1000 mW/cm2

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22. What happens to the visible light generated by QTH units that is not the correct wavelength to be absorbed by CQ?

a. Passes completely through restorative material b. Scattered by the glass filler particles into adjacent tooth structure c. Absorbed and converted into heat d. Reflected by the surface of the restoration as light e. Absorbed and re-emitted as infrared light 23. What is the largest volume of glass ionomer sold in the world today? a. Giomer b. Compomer c. Resin-modified glass ionomer d. Conventional glass ionomer e. Resin-reinforced glass ionomer for ART technique 24. What is the reason for BMPs? a. Provide legal protection for dentistry against OSHA b. Insure a healthy workplace and recycle hazardous materials c. Eliminate the use of dental amalgam in the dental office d. To protect patients from hazards of high-intensity visible-curing lights e. Insure infection control involving dental materials 25. What is the best management practice for insuring the greatest Hg/amalgam

recycling? a. Chair-side filters b. Suction line separators c. Non-contact amalgam recovery d. Office vacuums for collecting spilled Hg e. Special traps on sinks